Last Updated: December 19, 2023 | Reviewed and Edited by: Ortiz Law Firm
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Disability insurance benefits are meant to replace lost income in case of an accident or illness that prevents you from working. New York Life Insurance Company’s portfolio includes individual disability insurance and group long-term disability products for employers. The New York Life Group Benefits Solutions division typically handles NYL’s disability claims.
Unfortunately, disability insurance companies like New York Life do not always pay disability insurance benefits as they should, and legitimate disability claims are frequently denied. If you are looking for a disability attorney who fights back against New York Life disability denials, use our Contact Form to request a free disability case evaluation or call us at (888) 321-8131.Get a Free Case Review
Top Reasons for New York Life Disability Claim Denials
There are many reasons why New York Life Insurance Company may have denied your long-term disability claim, so you will have to review your denial letter to determine the specific reason for New York Life’s denial of your claim. If you are unsure why New York Life Group Benefits Solutions denied your claim, a disability attorney can help you understand why.
Reasons for denial include, but are not limited to:
- Insufficient medical records.
- Insufficient objective medical evidence.
- A non-verifiable medical condition or self-reported symptoms.
- Your doctors did not return the Attending Physician’s Statement.
- A Peer Review Physician disagrees with your doctor.
- You exaggerated symptoms to qualify for benefits.
- Video surveillance.
- Social media.
- You missed a deadline.
- You are disabled due to a pre-existing condition.
- You are disabled due to an expressly excluded condition.
- You do not meet the definition of disability in the policy.
- There has been a change in the definition of the term disability and
- You are only partially disabled.
Next, we’ll dig deeper into some of the policy provisions and limitations behind some of the most common reasons for claim denials:
You Do Not Meet the Definition of Disability
New York Life will deny your claim for benefits if it determines that you do not meet the definition of disability as stated in your policy. The following is an example from a New York Life disability insurance policy.
Covered Total Disability – A Covered Total Disability is an incapacity from the following which an Insured Person suffers while he or she is insured under the Policy:
1. an Illness, but only if such incapacity completely and continuously prevents the Insured Person from doing the material and substantial duties of his or her occupation, provided he or she is not engaged in any occupation for pay or profit; and
2. an organ donation by an Insured Person, if he or she has been continuously insured under the Policy for at least 6 consecutive months on the day of such donation.
You Have a Pre-Existing Condition
Most insurance companies include a pre-existing condition limitation in their policies. The following is an example from an actual New York Life policy:
Preexisting Condition means an Illness or any condition related to such Illness for which a person consults a doctor, receives medical services or supplies or takes any medication during the 12 month period immediately before the Insured Person’s Certificate Effective Date, if such Illness or condition is not fully disclosed when a request for initial insurance is made under the Policy.
Many insurers apply the pre-existing condition limitation inappropriately to deny claims. You should seek legal advice if denied based on the pre-existing condition limitation. Our team has extensive experience defending disability claims wrongfully denied due to a pre-existing condition limitation.
You Have a Mental Disorder or Chemical Dependency
Your claim may be approved initially, but most policies will only pay benefits related to a mental disorder or chemical dependency for a limited time. Here is an example from a New York Life policy:
The Maximum Benefit Period for all Covered Disabilities of an Insured Person which are due to or related to Mental Disorders and/or Chemical Dependency while such person is insured under the Policy, whether insurance has been continuous or interrupted, cannot exceed the lesser of: (a) 36 months; or (b) the Maximum Benefit Period for a Covered Total Disability.
Many insurers misapply mental health limitations to deny claims. You should seek legal advice if denied based on a mental health limitation. Our team has extensive experience defending disability claims wrongfully denied due to a pre-existing condition limitation.
Note: All the policy excerpts above are from a real New York Life long-term disability insurance policy.
Understanding New York Life Disability Claims
When initiating disability claims with New York Life, ensuring the accuracy and completeness of all documentation is crucial. Providing all the requested paperwork is equally essential, as incomplete claims can be grounds for delaying or denying your claim. While insurance companies may sometimes wait or reject claims for less apparent reasons, it’s vital to minimize this risk as much as possible.
How to Submit a Disability Claim to New York Life Insurance
To submit a disability claim, you must complete several essential forms, including the employee’s, employer’s, and attending physician’s statements. These forms will require details about you as the claimant and your disability. Additionally, authorization forms may require your signature, which must be submitted accurately and in full. Ensuring that you, your employer, and your physician thoroughly complete their respective sections is imperative, as incomplete information hinders the process.
Addressing Delays in Your New York Life Insurance Disability Claim
If you believe that your disability claim is experiencing delays, your first step should be to contact the New York Life Group Benefits Solutions to inquire about its status. You can either seek assistance from your employer in contacting the NYL GBS or call the customer service line to speak with a representative. If you encounter difficulties obtaining information about your claim’s status, you may want to consult an experienced disability lawyer.
The legal team at Ortiz Law Firm has extensive experience dealing with disability insurance companies. We can identify the strategies these companies use to delay benefit payments and work on your behalf to expedite the process and ensure timely receipt of your benefits.
What To Do After Receiving a New York Life Disability Denial
Despite the promises made when selling their group plan disability insurance policies to employers, New York Life frequently denies claims for disability benefits. If your claim is denied, you should receive a written copy of the decision by email or mail. The written decision should state why New York Life Group Benefits Solutions denied your claim, inform you about your right to file an appeal and note the deadline by which you must submit your appeal to New York Life.
After receiving your denial letter, you should also request a copy of your claim file and disability insurance policy. You will need your claim file to review all the information available for review when New York Life denied your claim. This includes your medical records, claim forms, and any other evidence New York Life obtained while reviewing your claim. It would be best if you also had your policy. It is the contract that governs your claim.
How to Appeal a Denial from New York Life Insurance Company
Fortunately, a claim denial is not the end for policyholders. The type of disability insurance policy you have will dictate whether it is governed by ERISA disability law and the process you must go through to recover your benefits.
- Group Disability Insurance Policies: If you have a New York Life disability policy obtained as part of a group benefits plan, your policy is likely governed by ERISA. ERISA disability insurance claims have strict appeal procedures and deadlines that you must adhere to. Under ERISA disability law, you must go through the administrative appeal process before filing a lawsuit against the insurer that denied your claim. You only get 180 days to appeal. If you do not file the required appeal within the designated time frame, you cannot take legal action against the insurer.
- Individual Disability Insurance Policies: Individual disability insurance claims and policies are not governed by ERISA. Suppose you have an individual disability policy, and your disability insurance benefits are denied or cut off prematurely. In that case, you may not have to file an administrative appeal to enforce your rights. You may be able to proceed directly to filing a lawsuit against New York Life Insurance Company. However, it may still be beneficial to appeal. You should request a free consultation with an experienced disability attorney to determine your legal rights and the best way to obtain your long-term disability benefits.
FREE RESOURCE: Whether you have a group or individual policy, we encourage you to check out our free step-by-step guide to appealing a disability insurance claim denial. The guide includes appeal templates and residual functional capacity forms.
How a New York Life Disability Attorney Can Help
If New York Life denied your long-term disability claim, we can help you recover the benefits that are rightfully yours. We are unafraid to take on New York Life or other major disability insurance companies.
Most individuals understandably wish to avoid the complexities of pursuing a federal ERISA disability lawsuit. After years of contributing to their insurance, policyholders rightfully expect their long-term group benefits to be administered promptly and fairly.
A skilled group long-term disability insurance attorney at Ortiz Law Firm can be instrumental in helping policyholders by:
- Assembling and presenting all the medical, occupational, vocational, and financial evidence required to support a successful claim, administrative appeal, or federal ERISA lawsuit: Insurance companies, such as New York Life, frequently cite “insufficient evidence to support the claim” for unjustly denying all or part of a claim. At Ortiz Law Firm, our accomplished long-term disability insurance lawyer understands the specific information insurers require to validate a claim. Our recognized attorney is adept at obtaining the necessary supporting documentation and presenting it effectively to the insurance company or the court when initiating a claim, administrative appeal, or pursuing a lawsuit in Federal ERISA court for an improper claim denial.
- Engaging in negotiations with insurance companies using language they understand: Mr. Ortiz presently only handles disability claims. With respect to long-term disability claims, Mr. Ortiz is an attorney who is well-versed in negotiating with large insurance companies like New York Life to secure benefits. A lawyer with extensive experience in group long-term disability matters, like Mr. Ortiz, is fluent in the terminology of insurance coverage and insurance laws. The Ortiz Law Firm knows policyholders’ legal rights and understands the appropriate pressure to apply to insurance companies to ensure a claim is processed fully, correctly, and fairly.
- Advocating for disabled policyholders during administrative appeals and federal ERISA lawsuits: Beneficiaries of New York Life group long-term disability insurance policies possess legal rights to pursue an administrative appeal and, when necessary, to escalate a dispute involving an unjust claim denial to federal court. However, they require competent legal representation in these proceedings. A single misstep at the outset of the administrative appeal process can jeopardize a claim permanently. When an insurance carrier, such as New York Life, wrongly denies all or part of a claim, individuals covered by the policy require the expert guidance of Ortiz Law Firm’s ERISA lawyer. Our attorney ensures that policyholders present a comprehensive, accurate case at every stage of their administrative appeal and federal ERISA lawsuit, safeguarding their rights and interests.
Our disability law firm offers a free disability policy review and consultation for those whose long-term disability claims have been denied. Nick A. Ortiz and his experienced legal team are experts in disability law and offer the following services:
- Appeal of a denial of individual or government disability benefits from New York Life.
- ERISA appeal of a New York Life Insurance Company denial of group disability claim.
- Appeal of a New York Life wrongful termination of individual or government long-term disability insurance claim.
- ERISA appeal of a New York Life Insurance Company wrongful termination of group long-term disability benefits.
- Filing a lawsuit against New York Life after final denial of individual or government disability claims.
- Filing an ERISA lawsuit against New York Life after final denial of group disability benefits and
- Lump-sum buyout or settlement of New York Life’s long-term disability policies instead of New York Life’s monthly long-term disability insurance benefits payments.
We do not typically handle all short-term disability claims. If you have a long-term disability claim that will also be affected, we may be able to help with both your short-term disability and long-term disability insurance claims.
What About New York Life Group Benefit Solutions Claims?
In 2020, New York Life Insurance Company acquired Cigna Group Insurance’s group life, accident, and disability insurance business and rebranded it as New York Life Group Benefit Solutions. The acquisition added more than 9 million customers to New York Life’s business portfolio, making it one of the largest carriers of group disability insurance.
We have experience with New York Life and Cigna Group Insurance claims, so the acquisition will not impact our ability to help claimants fight back against wrongful long-term disability insurance claim denials and terminations issued by New York Life Group Benefit Solutions.
What If I Also Need to Apply for Social Security Disability Benefits?
It is not unusual for disability insurance companies to require disabled individuals to file a claim for Social Security Disability (SSD) benefits. This is because, under most insurance policies, the insurer can reduce the amount they pay you monthly by the amount of the SSD benefits you receive.
If New York Life requests that you file for SSD benefits, we can assist you with that claim. Much of the medical evidence used to support your disability claim with New York Life can also be used to support a claim with the SSA, so it often makes sense to hire one disability attorney to handle both claims.
What Can I Expect If My New York Life Disability Claim Is Approved?
While this is good news, you mustn’t become complacent. In many cases, New York Life will immediately request an update from your attending physician or that you complete additional claim forms. They will continue to reevaluate your claim until you reach your maximum benefit period or they find a reason to justify the termination of your claim.
At Ortiz Law Firm, we continue to represent our clients after their claim is approved. This way, our clients are prepared for any unexpected developments, such as receiving a request for updated information or even a denial letter, which can occur without prior notice.Get a Free Case Review
New York Life Case Results
The following are just a sample of some of the NYL claims we have brought to a favorable resolution. Names have been withheld to protect our clients’ privacy.
Claim Approved Despite Independent Medical Examination: The claimant, a veteran in his 60s suffering from PTSD, Meniere’s disease, migraines, and herniated discs, contacted us after New York Life denied his short-term disability claim. We helped him submit a successful appeal, and his STD benefits were paid. We also helped him file a claim for long-term disability benefits, which was initially denied. We appealed the LTD denial, and New York Life overturned the decision and paid the long-term disability benefits.
Termination of “Any Occupation” Claim Overturned: The claim was initially approved based on the “own occupation” definition of disability. New York Life later ordered an independent medical examination and a vocational analysis. Based on these findings, New York Life closed the claim, stating that the claimant could perform “any occupation.” We appealed the decision, and after reviewing the appeal, New York Life reinstated the claim.
Claim Approved Despite Independent Physician Consultant Review: This client contacted us after being denied short-term disability benefits from New York Life Group Benefit Solutions. We helped with a second appeal and applied for long-term disability benefits. Despite additional evidence, an independent physician consultant review was required. After disputing the review findings, both the STD and LTD claims were approved.
Request a Free Consultation with a New York Life Disability Attorney
The Ortiz Law Firm specializes in disability claims with insurance carriers like New York Life and helps people with disabilities receive the pay they deserve. If New York Life Group Benefits Solutions has denied your disability case, the experienced legal team at our law firm can help.
If you are still gathering information, you can browse our free resources, which include:
- A free disability insurance appeal guide.
- Our collection of LTD FAQs.
- Educational articles about long-term disability claims.
If you’re ready to work with an attorney, you can also request a free case review. We will evaluate the specifics of your New York Life disability insurance claim to determine how we can assist you in obtaining the benefits you deserve.
Let us help get your claim approved. Call us today at (888) 321-8131 to request a free consultation with a New York Life disability attorney. We will not rest until we have recovered the disability insurance benefits you deserve.